1039 Hepatic Steatosis as an Indicator of Chronic Hepatitis B Virus Infection Severity

Abstract

INTRODUCTION: Chronic hepatitis B virus (HBV) infection is a leading cause of liver-related morbidity and mortality affecting 248 million individuals worldwide. Non-alcoholic fatty liver disease (NAFLD) is a common occurrence in chronic HBV infection. It ranges from simple steatosis to active inflammation of nonalcoholic steatohepatitis, and subsequent fibrosis, cirrhosis and an increase risk of hepatocellular carcinoma. Our study aims to assess the causal effect of NAFLD among chronic HBV patients. METHODS: We performed a retrospective chart review of all treated and untreated chronic HBV patients at Sandra Atlas Bass Center for Liver Diseases over the past 5 years. Medical records of study subjects with a diagnosis of NAFLD age ≥ 18 years and <90 years were reviewed. Patients were stratified into the following two groups: (1) mild-moderate steatosis (S0-S2) and (2) severe steatosis (S3). Patients with other co-existing chronic liver diseases were excluded. Clinical data as shown on Table 1 were analyzed. Continuous variables were statistically analyzed with student’s T-test. Categorical variables were analyzed with Pearson’s chi-squared test. RESULTS: We identified 110 patients with HBV infection and NAFLD, of which 68 (61.8%) patients had severe hepatic steatosis. Co-morbidities and ethnicities did not significantly differ among the two studied groups. Patients in the mild-moderate steatosis group had statistically higher HDL level (53.4 vs 46.6mg/dL, P = 0.033) and a lower ALT level (31.0 vs 47.7U/L, P = 0.027) than that observed in the severe steatosis group. Thirty-one percent of patients with severe steatosis were also found to have F2-F4 disease compared to 7% in the mild-moderate steatosis group (P = 0.013). Sixty-three percent of patients in the severe steatosis group required treatment with HBV anti-viral therapy compared to 31% in the mild-moderate steatosis group (P = 0.001). Tenofovir alafenamide (48.2%) was the HBV anti-viral therapy most commonly used. CONCLUSION: Our study showed that patients with severe steatosis tend to have lower HDL but higher ALT and fibrosis stage, and are twice as likely to require anti-HBV therapy. Hepatic steatosis may be an indicator of the severity of chronic HBV infection. Further studies are warranted to understand the correlation between NAFLD and chronic HBV infection.